Carotid Artery Endarterectomy in Patients Over Seventy Years-of-Age

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      Carotid artery endarterectomy in the elderly patient has been considered to be a high risk procedure. Recent revaluation, however, showed that advanced age alone doesn't seem to increase the perioperative surgical risk. We retrospectively reviewed the records for 222 carotid artery endarterectomies, not combined with any other type of surgery, in 195 patients over 70 years-of-age. Twenty-eight patients (14.3%) were asymptomatic, 43% were seen after transient ischemic attacks, 5.1% after reversible ischemic neurologic defects, and 37.4% after stroke. A standard operative protocol was followed. We used a shunt in 45.5% of patients, a standard endarterectomy was performed in 93% of patients, using a patch in 68%. There were three perioperative deaths and seven perioperative strokes in the series; total combined morbidity and mortality was 5.1%. In the 73 patients operated after previous stroke, three died and five suffered a perioperative stroke; total combined morbidity and mortality was 10.9%. In the 122 patients operated after previous transient ischemic attack or asymptomatic, two suffered a perioperative stroke; total combined morbidity and mortality was 1.6%. Late survival was identical to the survival of a normal Belgian control population, and stroke and death-free ratio at five years was 65%, 52% for patients operated after previous stroke and 69% for asymptomatic patients or patients operated after transient ischemic attack. Carotid artery endarterectomy can be performed in patients over 70 years-of-age with perioperative results equal to those of younger patients.

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